Private Higher Educational Institution “Kyiv

Medical University”

APPROVED BY
Department Chairman
M.D..,Professor.
Yakubova І. І.
As of August « 28 » 2019.
DEPARTMENT OF CHILDREN DENTAL THERAPY
Methodical Guidelines for Students
in discipline
“CHILDREN DENTAL THERAPY”
Subject №10
“Mycotic stomatitis in children.
Etiology, pathogenesis, clinical presentation, diagnosis, treatment”.

For the students of the 5th year, the

9th semester Faculty of Dentistry
Duration of Practical Training – 2,5 academic
hours

KYIV-2019
Methodical guideline has been developed by the Associate Professor
of the Department of Children Dental Therapy Kochyn O.V.
Discussed and approved at the department meeting of children dental therapy
August 28 2019 (protocol №1)
 RELEVANCE OF THE SUBJECT:
There has been a significant increase in mycotic lesions, including candidiasis, in
recent years. Clinical manifestations of candidiasis of the oral cavity mucosa are
various and may develop in children at any age. Understanding of the etiology,
pathogenesis of the disease and peculiarities of candidiasis clinical progression in
children allow pediatric dentists, along with related specialists, to solve the problem
of the treatment and prevention of fungal lesions.

LEARNING GOALS AND OBJECTIVES

1. To know the fungal diseases classification for the oral cavity mucosa.
2. To know etiological and risk factors for the development of acute and chronic
candidiasis of oral cavity mucosa in children.
3. To know clinical manifestations of acute pseudomembranous candidiasis in
children, depending on the disease severity.
4. To be able to perform diagnosis and differential diagnosis for acute and chronic
candidiasis of the oral cavity mucosa in children.
5. To know the treatment algorithms for acute pseudomembranous candidiasis of
varying severity in children.
6. To know antifungal agents groups, mechanism of action, indications,
contraindications and methods of use in childhood.
7. To know the basic prevention principles of fungal oral cavity mucosa lesions in
children of all ages.
THE LIST OF THEORETICAL ISSUES
1. Give a definition of the oral cavity candidiasis.
2. Name etiology and pathogenetic of mycotic stomatitis in children.
3. What factors affect candidiasis progression in children?
4. Name clinical manifestations of acute candidiasis in mild degree cases in children.
5. Name clinical manifestations of acute mycotic stomatitis in moderately-to
severely degree cases in children.
6. Name clinical manifestations of acute candidiasis in sever degree cases in
children.
7. Name patterns of clinical manifestations for chronic candidiasis of the oral cavity
mucosa in children.
8. What diagnostic methods of mycotic stomatitis do you know?
9. Name the treatment stages for acute candidiasis of the oral cavity mucosa in
children.
10.Name the treatment stages for chronic candidiasis of the oral cavity mucosa in
children.
11.Name groups, mechanism of action, indications, contraindications and methods of
use of antifungal agents in children.
12.What prevention remedies and measures for mycotic lesions of the oral cavity
mucosa in children do you know?
 LEARNING MATERIAL CONTENT:

Candidiasis – the diseases caused by Cryptococcus Candida, in particular, Candida

albicans, Candida tropicalis, Candida pseudotropicalis, Candida crusei, Candida
guilliermondi, and their association. They are facultative anaerobes, widespread in
the environment and often vegetate in the oral cavity. When reducing resistance of
the body of sickly children or elderly persons, fungi become pathogenic and
contribute to candidiasis development. In newborns, the disease can occur both as a
primary one and in association with transient immunodeficiency.
Clinically, oral cavity candidiasis may occur in the form of cheilitis, candida lesions
of the mouth corners (such as angular cheilitis), glossitis, stomatitis, gingivitis. It can
have both acute and chronic progression. Depending on the severity of the clinical
symptoms, the process may be localized or diffuse one.
Acute pseudomembranous candidiasis (oral moniliasis) in children is characterized
by hyperemia, mucosa swelling, and white plaque occurrence. It may have a mild,
moderate or severe degree of progression. With a mild degree of acute mycotic
stomatitis, white plaque, resembling “coagulated milk” – “cheesy-like” occur in some
areas of hyperemic mucous membrane. Plaque is easily removed without defect
formation, exposing the brightly hyperemic, desquamated mucous membrane. With a
moderately-to severely degree – membranous plaque is occurred on significant
areas of the oral cavity mucosa, in particular on the dorsum of the tongue, cheeks and
lips. Plaque can be removed only partially. After its removal, painful, erosive
surfaces remain, oral cavity mucosa is hyperemic is hyperemic and swollen. With a
sever degree, a diffuse lesion of the oral cavity mucosa is observed , including
soft and hard palatae, tonsils and the posterior pharyngeal wall, however, a thick
gray plaque with signs of adjacent tissues infiltration is occurred.
Chronic candidiasis occurs in somatically impaired children. It can occur in
association with primary and secondary immunodeficiency states. A long- term
progression with complaints of pain during meal and when opening mouth, fetor oris
are specific characteristics. Clinical peculiarities include lesions of all parts of the
oral cavity, occurrence of fragile plaque, colored in yellow or dark brown. When
attempting to remove plaque, bleeding erosion surface is exposed.
Candidiasis of the corner of the mouth (angular candida cheilitis, “mycotic cheilitis”)
occurs in children of preschool and school age, in particular, in patients with bad
habits, pathological type of bite (deep bite), decompensated degree of dental caries
activity, and architectural distortion of the lips. Objectively: deep fissures in the
corners of the mouth with thick, slightly raised edges are occurred, skin in these areas
is hyperemic, infiltrated, its maceration may be observed. Pain and bleeding are
occurred when opening mouth. The general condition of the child is undisturbed.
Diagnostics of the oral cavity mucosa candidiasis provides:
 Complaints of the patient (or his parents )
 Information of the objective examination
 Data of the lab tests: cytologic, microbiologic (mycological), molecular-
biological -( polymerase chain reaction)
Differential diagnosis for candidiasis of the oral cavity mucosa is performed in case
of:
• Acute herpetic stomatitis
• Benign migratory glossitis
• Streptococcal cheilitis
• Eczematous cheilitis
Treatment: the treatment is performed taking into account the clinical form of the
disease, severity, age of the child and general somatic condition. Etiotropic therapy of
the oral cavity mucosa candidiasis: polyene antibiotics: Nystatin suspension (1 000
000 OD) aqueous or in glycerol for oral mucosa treatment 3-4 times a day for 7-10
days, solution of Levorinum - natrium (20 000 OD) for treatment of oral cavity 3-4
times a day for 7-10 days, Nystatin ointment for applications to the oral cavity
mucosa and skin twice a day for a week. Azole compounds: 1% solution of
Clotrimazolum for applications to the oral cavity mucosa 3–4 times per day for a
week, 1% Clotrimazolum cream for applications to the skin 2–3 times a day for 2–4
weeks, 1% solution "Candide" (Clotrimazolum) for applications to the oral cavity
mucosa and skin 3-4 times per day for 3-5 days, 1% Candid (Clotrimazolum) cream
for applications to the oral cavity mucosa and skin 2-3 times per day for 1-2 weeks,
Fusys gel (Fluconazole) for skin applications 1 time per day for 1-3 weeks.
Allylamine compounds – Lamisil cream for skin applications 1 time per week.
In the treatment of the oral cavity mucosa candidiasis in infants, strict hygienic
regimen of mother and baby should be observed. All baby care items must be boiled.
The breast nipple of mother must be washed with boiled water, treated with 1%
sodium bicarbonate solution before feeding.
Chronic oral cavity mucosa candidiasis requires the use of long-term exposure
antifungal drugs (resorption of Nystatin pills, Levorinum, Clotrimazolum,
Decaminum enteric coated pills, applications of antifungal ointments: Nystatin,
Levorinum, Mycoheptinum, Amphotericin B. Irrigation of the oral cavity mucosa
with antifungal drugs should be performed 2-3 times per day for 10–15 days.
For the treatment of candidiasis lesions, imidazole, bio- and triazole substances -
Canesten (Clotrimazolum), ketoconazole (Nizoral), Miconazole (Daktarin) -
prescribed in the form of 1% ointment or 1% solution 3-4 times per day for 7-10
days. Effectiveness of the treatment increases with the simultaneous use of enzymes
in the form of bathes (0.2% solution of trypsin, Сhymopsin, Chymotrypsin, 0.25% of
lysozyme), as enzymes are synergists of antifungal drugs. In case of the oral cavity
mucosa candidiasis, there is a disruption of the mucous membrane structural
integrity, so it is advisable to use remedies that reduce inflammation and have an
epithelial effect: decoctions of medicinal herbs (sage, chamomile, St. John's wort,
crystal tea ledum, yarrow), oil solutions of vitamins, rosehip oil), jelly "Solcoseryl"
and ointment "Methyluracilum", "Panthotenic acid".
Prevention provides sanitation of the oral cavity and nasopharynx, a rational diet
except for easily digestible carbohydrates, hygienic care with sodium bicarbonate
solution rinsing. In the case of long-term administration of antibiotics - prescription
of antifungal drugs, vitamins, bacteriological control of intestinal microflora is
necessary.
To prevent oral moniliasis in newborns, prenatal rehabilitation of pregnant women is
required. It is important to observe hygiene regime in maternity hospitals.
PRACTICAL SKILLS (DENTISTRY MANIPULATIONS):
1. To master curation technique for pediatric patients with the oral cavity mucosa
candidiasis.
2. To draw a plan of the additional examination for pediatric patients with mycotic
stomatitis.
3. To perform differential diagnostics of acute oral cavity mucosa candidiasis with
different degrees of severity in children.
4. To draw a plan of the local treatment for oral cavity mucosa candidiasis in
children.
EXAMPLES OF TEST TASKS FOR STUDENTS 'SELF-TRAINING
1. A child at the age of 2.5 years old, has been restless, refusing to eat for several
days. The boy has been hospitalized for acute pneumonia, receiving antibiotics for
a week. At the examination: a grayish-white membranous plaque difficult to
remove with erosion formation has been revealed on hyperemic, swollen buccal,
labial and tongue mucosa. Determine a preliminary diagnosis.
A. Acute candida stomatitis of mild degree
B. Acute candida stomatitis of severe degree
C. Chronic candida stomatitis of mild degree
D. Acute candida stomatitis of moderate degree
E. Chronic candida stomatitis of moderate degree
2. Baby at the age of 2 months is restless, he has a poor sleep, refuses to eat. The
Body temperature is subfebrile. Objectively: cheesy plaque easy to remove by
tampon is observed on the hyperemic tongue, labial, buccal and palatine mucosa.
Regional lymph nodes are somewhat enlarged and painful on palpation. What
disease symptoms are presented to you?
A. Chronic atrophic candidiasis stomatitis
B. Acute pseudomembranous candidiasis stomatitis
C. Acute herpetic stomatitis
D. Diphtheria
E. Stomatitis in case of measles
3. A child at the age of 2 months has been ill for two days, he is restless, does not
eat well. Objective examination of the dorsum of the tongue has revealed punctuate
white stacks of layering, resembling coagulated milk. After removing them, a bright
red, swollen, intact surface remains there. What remedies should be used for the
etiotropic treatment of this disease?
A. Antifungal
B. Anti-anaerobic
C. Anti-allergic
D. Anti-inflammatory
E. Antiviral
4. A 16.5-year-old teenager has been troubled with a burning sensation for several
months. According to the anamnesis: chronic leukemia is occurred. Objectively:
oral cavity mucosa is pale and dry, saliva is viscous, frothy. Thick grayish-white
unremovable plaque is observed on the dorsum of the tongue. Determine a
preliminary diagnosis.
A. Chronic candida stomatitis
B. Acute candida stomatitis
C. Recurrent aphthous stomatitis
D. Recurrent herpetic stomatitis
E. Acute herpetic stomatitis
5. A child at the age of 7.5 years old has been troubled with burning sensation,
tenderness and bleeding when opening the mouth for several months. The boy has
a bad habit of licking and biting his lips. Examination in the corners of his mouth
has revealed fissures with swollen and hyperemic edges. What additional
examination is appropriate to use to determine the final diagnosis?
A. Immunological
B. Cytological
C. Virologic
D. Radiological
E. Microbiological
6. A 8-year-old child has been hospitalized for acute bilateral pneumonia for a
week. For the third day in a row the boy has been troubled with the burning
sensation and white plaque occurrence on the tongue. Objectively: membranous
stacks of layering are found on the dorsum of the tongue that are easy to remove
with exposure of a hyperemic, swollen, unaffected surface. Determine a
preliminary diagnosis.
A. Acute pseudomembranous candida stomatitis
B. Chronic atrophic candida stomatitis
C. Acute atrophic candida stomatitis
D. Chronic hyperplastic candida stomatitis
E. Chronic pseudomembranous candida stomatitis
7. Parents of a boy at the age of 4-months have complained of a white plaque
occurrence in his mouth. The child refuses to eat. Objectively: general condition is
satisfactory, the body temperature is 37.1ºC, and cheesy plaque easy to remove is
occurred on the labial and buccal mucosa. The mucous membrane under is
hyperemic and swollen it. A diagnosis of acute pseudomembranous candidiasis has
been determined. What ointment is used for etiotropic local treatment of oral
moniliasis?
A. Flucinar
B. Aciclovir
C. Solcoseryl
D. Clotrimazolum
E. Hydrocortisonum
8. Parents of a 3-month-old child are troubled about a white plaque occurrence in
her mouth. During the third day, the girl is restless, whimsical during
breastfeeding. Objectively: an easy removable cheesy membranous plaque has
been found on the buccal and tongue mucosa in association with swelling and
redness. Mucosa integrity after stacks of layering removing is not compromised.
Determine a preliminary diagnosis.
A. Acute candida stomatitis of moderate degree
B. Acute candida stomatitis of mild degree
C. Acute candida stomatitis of severe degree
D. Chronic candida stomatitis of mild degree
E. Chronic candida stomatitis of moderate degree
9. A 3-month-old infant is diagnosed with acute candida stomatitis of moderate
degree. What drugs should be used to treat the oral cavity?
A. 2-5% sodium hydrogencarbonate solution
B. Iodinol
C. Myramistinum
D. 10-20% borax liquor in glycerol
E. Viride nitens solution spirituous
10. Parents of a 6-month-old baby has complained of a plaque occurrence in their
baby's mouth. Objectively: oral cavity mucosa is hyperemic, covered with a white
plaque that resembles a coagulated milk; plaque is easy to remove. What is
causative agent of this disease?
A. Herpes simplex
B. Streptococcus pyogenes
C. Coxsackie virus
D. Varicella-zoster virus
E. Candida albicans

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